BRODBECK: Still big questions around hospital mergers

The closure of emergency departments at Concordia and Seven Oaks hospitals over the next year won’t be the only changes taking place at those facilities when the final phase of the Pallister government’s hospital consolidation plan kicks in.

The Winnipeg Regional Health Authority unveiled details of the second phase of its health care reorganization plan Thursday. While most of it was already known, WRHA officials continued to reveal more specifics about what the hospital landscape will look like in Winnipeg once the final pieces of the consolidation plan are implemented next year.

Seven Oaks is undergoing substantial change. Not only will its emergency department be converted to an urgent care centre in September – meaning it will no longer treat high-acuity patients – its intensive care unit will also close. And even though Seven Oaks has had the best outcomes in trauma orthopedic surgery in the province, and among the best in the country, that program will be closing there, too, and transferred to one of the three remaining acute care hospitals in the city.

Seven Oaks performed 98.6% of its trauma orthopedic surgeries – emergency surgery for broken joints like hips, legs and knees – within the 48-hour target, the best in the city and well above the national average of 87.5%, according to recent Canadian Institute of Health Information data.

Seven Oaks will retain its dialysis program, which provides treatment to people from all over the province.

Concordia will barely be a hospital at all, at least by conventional standards, once all the changes there are said and done. Its emergency department and its ICU are set to close in June 2019. There will be in-patient beds, but only for low-acuity patients. And there will be no urgent care service to replace the ER. In fact, there will be no walk-up medical service at Concordia whatsoever.

Even the orthopedic surgery performed there will be scaled back.

The big question, which still remains somewhat of a mystery, is whether the three remaining acute care hospitals – Grace, St. Boniface and Health Sciences Centre – will have the capacity to absorb the massive influx of patient volumes once the system consolidates from six acute care hospitals to three. WRHA officials insist they’re doing their due diligence in that regard and are adding sufficient bed, ICU, surgical and ER capacity at the three remaining acute care facilities.

However, a provincial task force report released in December found there was not adequate capacity at the three remaining acute care hospitals to handle the increased volumes, even with some of the planned expansions there.

It singled out St. Boniface Hospital in particular, which is already struggling with some of the longest length-of-stay wait times for admitted ER patients in the city. The task force found patient volumes would rise by a staggering 55% at St. Boniface once Concordia closed its doors as an acute care facility.

“The physical space in the existing (St. Boniface ER) is old and inadequate even for current volumes of patients,” the task force report said. “With the current space and patient flow, a 55% increase is not possible.”

That report convinced government to at least delay the closure of Concordia and stagger the changes at that facility with those planned for Seven Oaks. Originally, changes at both facilities were supposed to occur in the spring of 2018.

The task force was not opposed to consolidation in principle. But the report concluded government’s timeline was too ambitious. It even questioned whether Seven Oak’s ER should be closed at all.

Government and the WRHA assured the public when they first announced the consolidation plan in April 2017 that all of these capacity issues had been studied and worked out. We found out that was not the case when the task force report was released.

Have they been worked out since? And have the implementation delays allowed the WRHA to make the necessary planning and execution changes to address all of those capacity issues? That’s the big question. We won’t know until they implement it. But we do know they’re making changes along the way and they did not have it all worked out from the start like they claimed they did.

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